Objective: To explore associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risk of cardiovascular events in a Chinese population, with a long-term follow-up. Methods: A random sample of 2,031 participants (73.6% males, mean age = 60.4 years) was derived from the Asymptomatic Polyvascular Abnormalities Community study (APAC) from 2010 to 2011. Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay (ELISA). The composite endpoint was a combination of first-ever stroke, myocardial infarction (MI) or all-cause death. Lp-PLA2 associations with outcomes were assessed using Cox models. Results: The median Lp-PLA2 level was 141.0 ng/mL. Over a median follow-up of 9.1 years, we identified 389 events (19.2%), including 137 stroke incidents, 43 MIs, and 244 all-cause deaths. Using multivariate Cox regression, when compared with the lowest Lp-PLA2 quartile, the hazard ratios with 95% confidence intervals for developing composite endpoints, stroke, major adverse cardiovascular events, and all-cause death were 1.77 (1.24-2.54), 1.92 (1.03-3.60), 1.69 (1.003-2.84), and 1.94 (1.18-3.18) in the highest quartile, respectively. Composite endpoints in 145 (28.6%) patients occurred in the highest quartile where Lp-PLA2 (159.0 ng/mL) was much lower than the American Association of Clinical Endocrinologists recommended cut-off point, 200 ng/mL. Conclusion Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population. The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.
1-Alkyl-2-acetylglycerophosphocholine Esterase/blood* ; Asians ; Cardiovascular Diseases/diagnosis* ; China/epidemiology* ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Mortality ; Myocardial Infarction/blood* ; Predictive Value of Tests ; Risk Factors ; Stroke/blood*

myocardial infarction (AMI) and the difference between regions has not been reported in Korea since 2010. Thus, we aimed to inspect recent trends and regional differences in the incidence of AMI and case-fatality between 2007 and 2016.METHODS: Data from the medical utilization cohort from 2002 to 2016 were analyzed. New incidence of AMI was identified by checking the diagnosis code, duration of admission, type of test, treatment, and medication. Age-standardized incidence rate by gender, age group, and resident region was calculated from 2007 to 2016. Cumulative case-fatality rate was calculated until 3 years.RESULTS: Age-standardized incidence of hospitalized AMI decreased from 53.6 cases per 100,000 person-years in 2007 to 38.9 cases in 2011. Thereafter, the incidence gradually increased to 43.2 cases in 2016. The trend by gender and age groups was also similar to the total trend. The regional age-standardized incidence was the highest in Daegu (50.3 cases per 100,000 person-years) and the lowest in Sejong (30.2 cases), which were similar to the ischemic heart disease mortality in these regions. The 7-, 30-, and 90-days and 1- and 3-years average case-fatality over 10 years were 3.2%, 6.9%, 9.9%, 14.7%, and 22.4%, respectively.CONCLUSION: Although case-fatality continuously decreased from 2007 to 2016, hospitalized AMI incidence decreased from 2007 to 2011 and gradually increased from 2011 to 2016, with marked disparity between regions. Effective preventive strategies to decrease AMI incidence are required to decrease cardiovascular disease mortality in Korea.]]>
Cardiovascular Diseases ; Cohort Studies ; Daegu ; Diagnosis ; Humans ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Myocardial Ischemia

OBJECTIVES: Medically compromised patients often fear required dental surgical procedures that can increase the risk of medical emergency when combined with reduced tolerance for stress. A stress reduction protocol (SRP) helps doctors minimize treatment-related stress and improves patient management with minimum complications. Diabetes and co-morbid hypertension carry 4-fold risk of aggravation of cardiovascular emergencies and 7.2-fold risk of mortality. Diabetic neuropathy can result in difficult diagnosis of myocardial infarction and reduces chances of surviving a myocardial infarction compared with a non-diabetic person. The aim of the study was to assess the feasibility of a protocol for management of patients having both diabetes and hypertension who required minor oral surgery to minimize the rate of cardiovascular emergencies. MATERIALS AND METHODS: A prospective study was conducted in 140 patients having both diabetes and hypertension who required minor oral surgical procedures. A systematic approachable protocol was designed for management of such patients. RESULTS: Among 140 patients, 6 patients (4.3%) had cardiovascular complications, while 3 patients (1 with syncope and 2 with hypertension) did not require any intervention other than observation. Two patients were managed with aspirin and nitroglycerin, and 1 patient had possible myocardial infarction (overall incidence 0.7%) with chest pain, S-T segment elevation on electrocardiogram, and troponin level of 0.60 ng/mL. CONCLUSION: The proposed protocol helps to improve management of patients having both diabetes and hypertension. We recommend that patients with uncontrolled diabetes and uncontrolled hypertension and/or patients having history of cardiovascular complication should be treated in a medical facility with a readily available cardiology unit. This facilitates prompt response to emergency and instant implementation of treatment, helping to reduce morbidity and mortality.
Aspirin ; Cardiology ; Chest Pain ; Diabetic Neuropathies ; Diagnosis ; Electrocardiography ; Emergencies ; Humans ; Hypertension ; Incidence ; Mortality ; Myocardial Infarction ; Nitroglycerin ; Oral Surgical Procedures ; Prospective Studies ; Surgery, Oral ; Syncope ; Troponin

BACKGROUND AND OBJECTIVES: Ergonovine stress echocardiography (ErgECHO) has been proposed as a noninvasive tool for the diagnosis of coronary vasospasm. However, concern over the safety of ErgECHO remains. This study was undertaken to investigate the safety and prognostic value of ErgECHO in a large population. METHODS: We studied 3,094 consecutive patients from a single-center registry who underwent ErgECHO from November 2002 to June 2009. Medical records, echocardiographic data, and laboratory findings obtained from follow-up periods were analyzed. RESULTS: The overall positive rate of ErgECHO was 8.6%. No procedure-related mortality or myocardial infarction (MI) occurred. Nineteen patients (0.6%) had transient symptomatic complications during ErgECHO including one who was successfully resuscitated. Cumulative major adverse cardiac events (MACEs) occurred in 14.0% and 5.1% of the patients with positive and negative ErgECHO results, respectively (p < 0.001) at a median follow-up of 10.5 years. Cox regression survival analyses revealed that male sex, age, presence of diabetes, total cholesterol level of >220 mg/dL, and positive ErgECHO result itself were independent factors associated with MACEs. CONCLUSIONS: ErgECHO can be performed safely by experienced physicians and its positive result may be an independent risk factor for long-term adverse outcomes. It may also be an alternative tool to invasive ergonovine-provoked coronary angiography for the diagnosis of vasospastic angina.
Cholesterol ; Coronary Angiography ; Coronary Vasospasm ; Diagnosis ; Echocardiography ; Echocardiography, Stress ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Mortality ; Myocardial Infarction ; Prognosis ; Risk Factors

Aortic dissection is an uncommon, life-threatening medical emergency that is associated with a high mortality rate, and death from aortic dissection is mainly related to secondary complications, namely cardiac tamponade, severe aortic regurgitation, acute myocardial infarction, and abdominal organ vessel obstruction. Hence, prompt and accurate diagnosis followed by proper treatment is important for patient survival. Herein, we present a rare case of sudden death after aortic dissection with concomitant acute myocardial infarction and cardiac tamponade.
Aortic Valve Insufficiency ; Autopsy ; Cardiac Tamponade ; Coronary Vessels ; Death, Sudden ; Diagnosis ; Emergencies ; Humans ; Mortality ; Myocardial Infarction

PURPOSE: This study aimed to evaluate the clinical findings in pediatric rhabdomyolysis and the predictive factors for acute kidney injury (AKI) in Korean children. METHODS: Medical records of 39 Korean children, who were newly diagnosed with rhabdomyolysis from January 2008 to December 2015, were retrospectively analyzed. The diagnosis was made from the medical history, elevated serum creatinine kinase level >1,000 IU/L, and plasma myoglobin level >150 ng/mL. Patients with muscular dystrophy and myocardial infarction were excluded. RESULTS: The median patient age at diagnosis was 14.0 years (range, 3–18 years), and the male to female ratio was 2.5. The most common presenting symptom was myalgia (n=25, 64.1%), and 14 patients (35.9%) had rhabdomyolysis-induced AKI. Eighteen patients (46.2%) had underlying diseases, such as epilepsy and psychotic disorders. Ten of these patients showed rhabdomyolysis-induced AKI. The common causes of rhabdomyolysis were infection (n=12, 30.7%), exercise (n=9, 23.1%), and trauma (n=8, 20.5%). There was no difference in the distribution of etiology between AKI and non-AKI groups. Five patients in the AKI group showed complete recovery of renal function after stopping renal replacement therapy. The median length of hospitalization was 7.0 days, and no mortality was reported. Compared with the non-AKI group, the AKI group showed higher levels of peak creatinine kinase and myoglobin, without statistical significance. CONCLUSION: The clinical characteristics of pediatric rhabdomyolysis differ from those observed in adult patients. Children with underlying diseases are more vulnerable to rhabdomyolysis-induced AKI. AKI more likely develops in the presence of a high degree of albuminuria.
Acute Kidney Injury* ; Adult ; Albuminuria ; Child ; Creatinine ; Diagnosis ; Epilepsy ; Female ; Hospitalization ; Humans ; Male ; Medical Records ; Mortality ; Muscular Dystrophies ; Myalgia ; Myocardial Infarction ; Myoglobin ; Phosphotransferases ; Plasma ; Psychotic Disorders ; Renal Replacement Therapy ; Retrospective Studies ; Rhabdomyolysis*

BACKGROUND/AIMS: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy. METHODS: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128). RESULTS: In this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time (2,618 ± 381 minutes vs. 1,739 ± 241 minutes, p = 0.050), the symptoms-to-balloon time (3,426 ± 389 minutes vs. 2,366 ± 255 minutes, p = 0.024), and the door-to-balloon time (2,339 ± 380 minutes vs. 1,544 ± 244 minutes, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487). CONCLUSIONS: Acute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.
Acute Coronary Syndrome ; Chest Pain ; Diagnosis ; Humans ; Korea ; Mortality ; Myocardial Infarction* ; Propensity Score ; Reperfusion

PURPOSE: Critical care transport (CCT) has been known to be beneficial for inter-hospital transport of critically ill patients. Seoul Mobile Intensive Care Unit (SMICU) has been established and provided CCT in Seoul Metropolitan City since 2015. We tested the association between SMICU transport and hospital outcome for critically ill patients. METHODS: This is a before and after intervention study. SMICU group with cardiac arrest, acute myocardial infarction, acute stroke, major trauma, respiratory failure, and shock who were transported by SMICU from January to July 2016 were collected as an intervention group. Non-SMICU group with the same above diagnosis criteria who were transported by private ambulance services during same period in 2015. By National Emergency Department Information System (NEDIS), demographics were compared for original data and sampling data. Multivariable logistic regression analysis was done to calculate the adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) adjusting for potential confounders. RESULTS: Total 1,837 patients (128 SMICU and 1,709 non-SMICU group) for original dataset and 180 patients (60 SMICU and 120 non-SMICU group) for sampling dataset were finally analyzed. Hospital mortality rates are 22.7% in SMICU and 11.8% in non-SMICU in original dataset (p<0.001), 26.7% in SMICU and 31.7% in non-SMICU in sampling dataset (p=0.490), respectively. AOR (95% CIs) for hospital mortality by SMICU in original and sampling dataset were 0.80 (0.48-1.35) and 0.71 (0.33-1.51), respectively. CONCLUSION: The CCT for critically ill patients did not show significantly better hospital mortality in the pilot study.
Ambulances ; Critical Care* ; Critical Illness* ; Dataset ; Demography ; Diagnosis ; Emergency Medical Services ; Emergency Service, Hospital ; Heart Arrest ; Hospital Mortality ; Humans ; Information Systems ; Intensive Care Units ; Logistic Models ; Mortality ; Myocardial Infarction ; Odds Ratio ; Pilot Projects ; Respiratory Insufficiency ; Seoul ; Shock ; Stroke ; Transportation of Patients

BACKGROUND: Off-pump coronary artery bypass (OPCAB) is performed worldwide, but significant risks are associated with conversion to on-pump surgery. Therefore, we evaluated the composite outcomes between an OPCAB group and a conversion group. METHODS: From January 2008 to December 2012, 100 consecutive patients underwent OPCAB at Hallym University Sacred Heart Hospital, of whom 84 underwent OPCAB without adverse events (OPCAB group), and 16 were converted to on-pump surgery (conversion group). Early morbidity, early and long-term mortality, and major adverse cardiac and cerebrovascular events (MACCEs) were the primary and long-term composite endpoints. RESULTS: The mean follow-up period was 55±26 months, with 93% of the patients completing follow-up. The composite outcomes in the OPCAB and conversion groups were as follows: early morbidity, 2.3% versus 12.5%; early mortality, 4.7% versus 0%; long-term mortality, 14.3% versus 25.0%; and MACCEs, 14.3% versus 18.8%, respectively. No composite endpoints showed statistically significant differences. Preoperative acute myocardial infarction (AMI) was identified as an independent risk factor for conversion (p=0.025). CONCLUSION: The conversion group showed no statistically significant differences in early mortality and morbidity, MACCEs, or long-term mortality compared with the OPCAB group. The preoperative diagnosis of AMI was associated with an increased number of conversions to on-pump surgery.
Coronary Artery Bypass* ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels* ; Diagnosis ; Follow-Up Studies ; Heart ; Humans ; Mortality ; Myocardial Infarction ; Risk Factors*

BACKGROUND/AIMS: Angiotensin II type 1 receptor blockers (ARBs) have not been adequately evaluated in patients without left ventricular (LV) dysfunction or heart failure after acute myocardial infarction (AMI). METHODS: Between November 2005 and January 2008, 6,781 patients who were not receiving angiotensin-converting enzyme inhibitors (ACEIs) or ARBs were selected from the Korean AMI Registry. The primary endpoints were 12-month major adverse cardiac events (MACEs) including death and recurrent AMI. RESULTS: Seventy percent of the patients were Killip class 1 and had a LV ejection fraction > or = 40%. The prescription rate of ARBs was 12.2%. For each patient, a propensity score, indicating the likelihood of using ARBs during hospitalization or at discharge, was calculated using a non-parsimonious multivariable logistic regression model, and was used to match the patients 1:4, yielding 715 ARB users versus 2,860 ACEI users. The effect of ARBs on in-hospital mortality and 12-month MACE occurrence was assessed using matched logistic and Cox regression models. Compared with ACEIs, ARBs significantly reduced in-hospital mortality(1.3% vs. 3.3%; hazard ratio [HR], 0.379; 95% confidence interval [CI], 0.190 to0.756; p = 0.006) and 12-month MACE occurrence (4.6% vs. 6.9%; HR, 0.661; 95% CI, 0.457 to 0.956; p = 0.028). However, the benefit of ARBs on 12-month mortality compared with ACEIs was marginal (4.3% vs. 6.2%; HR, 0.684; 95% CI, 0.467 to 1.002; p = 0.051). CONCLUSIONS: Our results suggest that ARBs are not inferior to, and may actually be better than ACEIs in Korean patients with AMI.
Angiotensin II Type 1 Receptor Blockers/adverse effects/*therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/adverse effects/*therapeutic use ; Chi-Square Distribution ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Multivariate Analysis ; Myocardial Infarction/diagnosis/*drug therapy/mortality/physiopathology ; Proportional Hazards Models ; Prospective Studies ; Recurrence ; Registries ; Republic of Korea ; Risk Factors ; Secondary Prevention/*methods ; Stroke Volume ; Time Factors ; Treatment Outcome ; Ventricular Function, Left